LAUSR

The impact of positive airway pressure (PAP) therapy on healthcare cost among patients with obstructive sleep apnea (OSA) requires further exploration. This study evaluated the associations between PAP adherence and cost in a large integrated healthcare system. The study included adult patients with OSA (apnea-hypopnea index (AHI) ≥5) with available PAP therapy data between 1/1/2015 to 8/31/2019 from Kaiser Permanente Southern California. We followed the identified patients from the date of highest AHI before PAP use (index) up to 2 years. Each patient had PAP usage and cost organized into 6-month intervals, and mean hours/night and cost was calculated for each interval. Patients were stratified into the following adherence groups: (a) high adherence (≥4 hours/night consistently across all intervals); (b) moderate adherence (2–3.9 hours/night or ≥4 hours/night in some but not all intervals); (c) low adherence (< 2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs associated with PAP adherence were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI. Stratified analyses based on age (< 65, ≥65 years) and AHI (< 15, ≥15) were conducted. A total of 25,700 patients (63.3% male; 41.6% with AHI ≥30) were included in the study. Among those, 53.2% (n=13,684) categorized as having low PAP adherence, 24.2% (n=6221) as moderate adherence, and 22.5% (n=5795) as high adherence. High adherence was associated with the lowest average multivariable adjusted 6-month healthcare cost ($3,586, 95% CI: $3,428, $3,745) compared with moderate ($4,035, 95% CI: $3,859, $4,211) and low ($4,232, 95% CI $4,110, $4,355) adherence. The cost differences between “high vs low” and “moderate vs low” adherence were $646 (p< 0.001) and $197 (p=0.050), respectively. The cost differences between “high vs low” adherence were $999 (p< 0.001) for those with ≥65 years and $657 (p< 0.001) for those with AHI ≥15. Better PAP adherence was associated with significantly lower healthcare costs in patients with OSA although further understanding of the relationship is needed. KPSC Regional Research Committee Grant: KP-RRC-20210506.